medwireNews: Regular use of opioid pain relief by US patients with rheumatoid arthritis (RA) increased until 2010 and has since declined slightly, researchers report.
“[O]ur results suggest substantial use of opioids in an older RA population despite societal concerns regarding potential over-prescribing in recent years,” say Jeffrey Curtis (University of Alabama at Birmingham, USA) and study co-authors.
In an analysis of national Medicare data, the team found that approximately 43% of 70,929 RA patients regularly used opioids in 2007, rising to approximately 47% of patients in 2010, and decreasing to around 44% in 2014.
Patients were aged a mean of 67.4 years, and regular opioid use was defined as the filling of at least three prescriptions, or one or more prescriptions for at least a 90-day supply of opioids, per calendar year.
The most commonly used opioids in 2006 were medications combining acetaminophen with hydrocodone or propoxyphene, while the use of hydrocodone and tramadol increased following the withdrawal of propoxyphene from the US market in 2010.
Patients regularly using opioids in 2014 were younger than those who used the drugs intermittently or did not use opioids (67.3 vs 70.8 and 71.8 years), and a higher proportion of regular users were female (80.0 vs 76.4 and 75.0%) or of Black ethnicity (12.0 vs 9.2 and 7.9%). Regular users were also more likely to have comorbidities, including depression, anxiety, back pain, and soft tissue rheumatism including fibromyalgia.
These findings “raise the concern that some prescribing decisions may not have been appropriate,” say the authors, noting that “there is no trial evidence for long term opioids being helpful in fibromyalgia, and patients with depression and anxiety may be at greater risk for harm, including overdose, when taking opioids.”
However, they caution that the database study was not able to determine whether individual decisions reflected the optimum balance of risk and benefit for each patient.
Curtis and colleagues also identified “substantial variability” between rheumatologists in the proportion of their patients who received opioids, with unadjusted proportions ranging from 0 to 93%. After adjustment for factors including comorbidities and socioeconomic status, a patient was 25% more likely to receive opioid treatment if a similar patient in the same rheumatologist’s practice also received opioids.
The team warns that their study was limited by the majority of patients in the database being over 65, meaning that the findings “have uncertain generalizability to younger RA patients.”
And they conclude in Arthritis & Rheumatology: “Although the present findings are insufficiently granular to prove inappropriate practice, they do raise concerns.
“Moreover, they certainly reinforce parallel needs for individualized care and increased efforts to develop new and effective pain interventions for patients with rheumatoid arthritis.”
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